How is ochronotic arthritis treated?
Treatment for symptom alleviation of the arthritis as for osteoarthritis is the standard therapy and includes patient education, physical and/or local therapy, and analgesia. Dietary restriction of phenylalanine and tyrosine is indicated. Vitamin C therapy is controversial. Total joint arthroplasty is necessary in over 50% of patients by age 55. Arthroscopy has been beneficial for removal of osteochondral loose bodies in the knee. Nitisinone (Orfadin) is currently under investigation for the prevention and treatment of ochronosis. This drug inhibits the enzyme 4-hydroxyphenylpyruvic acid dioxygenase which produces HA. A recent trial (2011) reported that it was not effective once arthritis was established. It is unknown if earlier treatment could prevent the development of arthritis, but trials looking at earlier use of nitisinone are ongoing.
